South Africa: Health Program Integration: The Benefits of Mental Health Screening (December 2010)

Kevin Stoloff, who works at the Langa Community Clinic in Cape Town, speaks about the benefits of mental health screening for individuals who have just been informed about their HIV-positive status.

I began working in HIV mental health determined to engage in mental health activism. This involves promoting the concept of mental wellness, increasing awareness and knowledge of mental health problems among users and healthcare workers, and attempting to influence policy-makers to incorporate mental health programs into routine primary health care. HIV affords us an opportunity to create an integrated model for the holistic treatment of serious illnesses.

With support from the United States through the President's Emergency Plan for AIDS Relief (PEPFAR), the Langa Community Clinic is now screening people living with HIV/AIDS for mental health problems, and providing mental health literacy in the form of training modules to lay counsellors and home-based carers.

Nondumiso's story

Nondumiso, a 28-year old pregnant woman from Langa, was recruited into our program, which screens HIV-positive people not yet on antiretroviral therapy. She had been diagnosed HIV-positive three months earlier during a routine pregnancy check-up. After testing positive, as is sometimes the case, Nondumiso was rejected by her partner due to her HIV status.

Nondumiso developed symptoms indicative of depression, including an inability to enjoy things she previously loved, difficulty getting motivated to go to work, and difficulty sleeping. In addition, she felt pessimistic about her future. As a consequence of these symptoms, she missed numerous days at work, and lost her job. During multiple contacts with healthcare workers prior to this time, the depression was not diagnosed. Nondumiso was unaware that she was depressed, and that people living with HIV/AIDS are at double the risk for this mood disorder.

At the Langa Community Clinic, Nondumiso was prescribed antidepressant medication, and several sessions with our mental health nurse, who explored the difficulties in a sensitive, supportive way. During the sessions, Nondumiso and the nurse discussed issues regarding fear of disclosure and stigma. They also spoke about HIV and its prognosis in this era of antiretroviral treatment, and corrected common misconceptions. The nurse provided information about the symptoms and causes of depression, and about simple lifestyle changes that could help alleviate some of these symptoms.

The mental health nurse helped Nondumiso work through some of her problems. They discussed steps for Nondumiso to re-engage in dialogue with her ex-partner, and creative ways of distributing Nondumiso's resume so that she could get a new job. They also made a plan for Nondumiso to disclose her HIV status to her family, so that she could feel supported and not alone.

After four sessions with the mental health nurse, and the initiation of antidepressant medication, Nondumiso felt excited about her future and empowered to face the difficulties ahead. Her sleep improved, and dialogue with her ex-partner resumed.

Nondumiso's story is an example of a common scenario where early detection and simple intervention can help alter attitude, mood, and general well-being in people living with HIV/AIDS. In our attempts to address HIV/AIDS, it is vital that we regard mental well-being as a necessary component of general health.